CAMH and Women’s College launch refugee mental health service

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March 24, 2016 - A new treatment service for refugees is the latest addition to CAMH’s comprehensive refugee mental health programming.

The New Beginnings Clinic, launched in partnership with Women’s College Hospital Crossroads Clinic, opened in March. The clinic offers consultation to GTA-area physicians and outpatient services for their refugee clients. It’s a timely step forward in CAMH’s local, national and global efforts on refugee mental health -- as Canada welcomes more than 25,000 Syrian refugees.

Refugees are focusing on the necessities of life including a new home, food, clothing, education and employment opportunities, says Clinic Manager Stephanie Carter, CAMH Mood and Anxiety Ambulatory Services. “At the same time, some of them need care for trauma they have experienced and related mental health issues.”

New Beginnings is available to any refugee who lives in the GTA and has arrived in Canada within the past two years, and who is referred by their general practitioner. The service is located within the Mood and Anxiety Ambulatory Service at 100 Stokes Street on CAMH’s Queen Street West site.

Key referral sources include Crossroads and its network of 29 primary care clinics, as well as COSTI Immigrant Services, an agency that provides educational, social, and employment services to help all immigrants in the Toronto area become self-sufficient in Canadian society. The CAMH New Beginnings Clinic will also accept referrals from other GTA physicians through other sources such as family health teams and community health centres, says Stephanie.

Dr. Meb Rashid

“For refugees, obtaining readily accessible mental health assessment and treatment can often be a challenge,” says Dr. Meb Rashid, Director of the Crossroads Clinic. It has provided care to more than 1,500 refugees from dozens of different countries since Crossroads opened in 2011. “The New Beginnings service will go a long way to providing newly arrived refugees with the mental health support they need to successfully integrate into Canadian society.”

The service has two components:

• Case consultation for physicians - providing primary care providers with access to psychiatrists and social workers for discussion and advice on their refugee client/patient cases.

• Psychiatric consultation and treatment for refugee patients – including brief culturally sensitive interventions for newly-arrived refugees who have psychological issues or concerns.

Patients will have immediate access to interpretation for Arabic and other languages through CAMH’s interpretation service, which already handles about 3,500 requests each year. Interpretation is available within one minute by phone, or face-to-face in a scheduled visit.

The new clinic’s two consulting psychiatrists, Dr. Clare Pain and Dr. Lisa Andermann, have assisted hundreds of refugees over the past several years, through their affiliation with the Canadian Centre for Victims of Torture. They will use culturally-informed assessment approaches – such as the DSM Cultural Formulation Interview -- and awareness of the principles of narrative-focused therapy. But they say often the key is to focus on understanding refugees’ immediate needs.

“Refugees are highly resilient,” says Dr. Pain. “Many have had a good early life. They have survived a traumatic experience later in life with their experiences of war and forced migration. It’s a matter of being open to and aware of their immediate situation and needs.”

For example, an impending refugee hearing – what could be the most important day of a refugee’s life – can be a huge stressor, says Dr. Andermann. “Likewise, challenges around employment, housing, and separation from family back home can cause a high amount of distress for a person after they arrive.”

At the same time, some refugees do have more complex mental health conditions that require the full range of treatment options, says Dr. Pain. She notes that her first priority is consultation to primary care physicians, since most mental health issues for refugees will be addressed in the community. She and Dr. Andermann also began to see patients one-on-one when the clinic opened in March at CAMH. The new service will evolve to meet demand as the “surge” continues with Syrian refugees arriving in Canada, and is open to refugees from all backgrounds who required mental health services.

Both physicians also bring extensive experience in trauma. Dr. Pain is Director of the Psychological Trauma Program at Mount Sinai Hospital. Dr. Andermann works with patients at that clinic, and through Mount Sinai’s Ethnocultural ACT team.

“This is a great example of how sharing expertise through partnership can extend our reach and ensure that people are getting the help they need when they need it,” says Neill Carson, Executive Director, CAMH Ambulatory and Structured Treatments Program.

“CAMH has had long involvement with education and research in the field of refugee mental health,” he says. “The addition of this focused clinical service can ensure that primary care physicians in the front line of this work have the support they need from mental health specialists.”

Dr. Branka Agic

Dr. Branka Agic, CAMH’s Health Equity Manager and a key player in CAMH refugee initiatives, summed it up: “The most important needs for refugees are a sense of hope and opportunity based on community support. In turn, refugees have a tremendous capacity to move forward and enrich the society that has welcomed them.”